have

Mr. LEVITT. You might note that I am not wearing a tie. one with me but I am dressed right more for Key West where I live, which is 160 miles south of here. I am contributing to the energy crisis by not wearing a tie and I might suggest we get rid of ties and jackets and cut down the air-conditioning and sweat a little bit.

Mr. HEFTEL. Excuse me while I strip for action and turn off the air-conditioning.

Mr. RANGEL. Unfortunately, my hotel agreed with you and didn't tell me about it.

Mr. LEVITT. I spent 12 years in Hawaii commanding a CID section there with the military police department in Honolulu. That is why I am in Key West because it is very similiar to the old Honolulu that I know except that we have a large Hispanic population as against the Oriental population in Honolulu.

I would like to emphasize the nitty-gritty of your advocacy for a national health insurance program. There were two bills passed in the State of Florida last year and I was chairman of the legislative committee of our organization. One was community care for the elderly. In 1977 I served as chairman of the board of trustees of the Florida Keys Memorial Hospital and I was appointed to a State job and I am a commissioner on the Commission on Human Relations. I have some knowledge of what goes on in hospitals.

Basically it is a monopolistic practice; the doctor determines what is to happen with you. There is no other alternative. You can't go to a veterinarian and you can't go to a witch doctor. The doctor determines your fate. The doctor sets a fee and there is nobody to monitor that. The hospital sets charges and there is no one to monitor that. We did pass a hospital cost containment bill in the State of Florida and we do have now the right under this commission to subpena records and to make an overview and then to publicize. That is all we can do. We cannot correct the rates but we can tell the community that hospital X is charging too much money, and we hope that that will have an effect. Now on community care for the elderly, we passed a 2-year bill in the last session and I want to offer that as a way of aiding older people who need help. In my experience, the most expensive way of handling people is the nursing home. It is far better to leave an individual in his or her home where they know where the bathroom is, where they know where the closet is, and where you send in a hot meal every day, and where you send in a home health person to take the blood pressure or to give a shot, where you send somebody in to do the chore work, where you send somebody in to do the shopping, and where you send someone in to hold a hand.

It is cheaper. Under community care for the elderly, that is the route being taken in Florida.

Now I say to you that if we go that route, we will cut health costs. We have two hospitals in Key West. One is a proprietary hospital and the other is a tax base hospital of 125 beds. We received some Hill-Burton money and of course you know the route we have to take. Somebody came down and said, "We need 125 beds," and we never have used more than 75. During my term I opened a nursing home in 30 of those beds and we make no money in it because we get a great deal of medicaid people, and recently, within the last 8 months, 10

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doctors bought the 30-bed proprietary hospital. Now you know and I know they didn't buy it to practice better medicine. It is very simple for an administrator to inform medical staff doctors that the census is down. The payroll stays up because you cannot go down to Sears & Roebuck and get a nurse or get somebody that is knowledgeable. You have to maintain your staff and your census is down and payroll costs skyrocket.

You are in the red. It is very simple for an administrator to give this information to the medical staff, and then immediately people start to get into the hospital. They say, "We will put you in for 3 days and we will run you some tests," and all you have is a pimple on your nose. You get a bill of $1,000. The system is bad. Now let me give you the other side of it.

Having been chairman of a board of trustees we must maintain staff; we know that. We do get a great amount of people that come in that don't pay their bills. During the time I was chairman in the year 1977, we were running slightly over $3 million gross and I found myself with $800,000 worth of no pay bills. You also know that medicare audits us on a regular basis and every 3 months I found out we owed medicare $50,000 because people were kept in the hospital too long.

Instead of a 15-day stay they should only have been there for 10 days.

A young man wants to be a doctor. At 19 he goes to college 4 years and at 22 he goes to medical school, and at 26 he now goes into internship and at 28 or 30 he comes out and he is in hock up to his eyeballs. Maybe he was lucky and he got married and he has a child, and when he comes out he is interested in m-o-n-e-y. He wants to get out from under. Once they go that route, it seems none of them break away from it. They all keep on going down the line trying to earn more and more money. The system is bad. We must find a better way.

Mr. RANGEL. Let me interrupt by saying, Mr. Levitt, that your associations, and I have attended several of your meetings, are doing a tremendous job in bringing this problem to Members of Congress. As I was stating earlier with the monsignor, it is necessary to have this balance but this fine work, especially since you have joined together, that is being done has been of tremendous assistance to my subcommittee as well as to Chairman Waxman who chairs the Health Subcommittee for the Interstate and Foreign Commerce Committee. So I just want to state for the record that your contribution is really felt and we hope to be able to handle some type of proposal that will meet the needs of your associations.

Mr. HEFTEL. Your testimony is very comprehensive and well thought out and you should be complimented. I think the principal part of your testimony that we should all take note of is that the Government, if it is going to go participating in the health system, must have a way of controlling the fee schedule process. Until we do that, we are adding to the inflationary spiral of medical care in the country. Mr. RANGEL. Thank you so much.

The next is Max Serchuk, Dade County Council for Senior Citizens, Florida Health Coalition, and after your testimony we will break for 10 minutes and give the stenographer a break here and then immediately proceed.

STATEMENT OF MAX SERCHUK, REPRESENTING THE DADE COUNTY COUNCIL OF SENIOR CITIZENS

Mr. SERCHUK. Today we have heard a whole history of Florida and the problems and statistics and everything else. I would like to talk about one man in the street, how he looks at the problem. This is what I am trying to do here today. I am speaking for our 50,000 members affiliated in the National Council of Senior Citizens who reside in Florida. To my knowledge from counseling I was serving on the south Florida system agency and the day-to-day experiences of our membership that comes into our office.

In Miami Beach with a population of 92,000 people, over 50 percent are social security recipients. Our membership living on fixed incomes need a major illness to be able to profit by medicare extensively. The rising costs of medical services makes it more difficult for people to avail themselves of needed health services. Let us take a look at rising costs.

One must recognize that new methods of treating disease require personnel and procedures that are costly; second, more use of hospitals to treat disease; third, we are living to older ages, where more diseases occur; and fourth, there is the old question of supply and demand, where the demand now is rising faster than the supply of health personnel.

From all of these reasons it contributes to a higher health cost. As a fact, there is no real control of health costs and we can only foresee under present conditions costs will be much higher. In our city on Washington Avenue you see an elderly person crossing over the street and right in front of him is a sign that says "No jaywalking," or he may cross the street against the traffic lights. He is violating the law. If there is a police officer there he will get a ticket, and he will pay a $5 fine. This person is not breaking any law. He cannot see and he needs glasses and he can't afford a doctor for the glasses. We talk about reasonable costs in medicare.

Reasonable costs to most of our people is a cruel hoax. In the first place, they can't afford $60 deductible or $20 coinsurance. If that is not bad enough, there is an unreasonable charge and the patient winds up paying 50 percent of the doctor's charge. Yes, the average senior citizen of Miami Beach lives with a sword of Damocles over his head. Where does he go? He either gives up something that he needs and sometimes it is part of his food, or as sometimes happens by going to a doctor and accumulating bills that he cannot pay. He sometimes sells his house to pay his medcal bills. However, in Miami Beach he has another alternative. He goes to one of the many clinics operating up on Miami Beach, and some of these clinics have as many as 10 doctors treating the patients. My members tell me that the usual procedure is on your first visit you usually get an EKG, X-rays, and a blood test and the bill to medicare runs usually $120. Of course, these services were rendered, but were they needed?

Speaking of the plight of senior citizens, one must realize that exorbitant health costs affect not only the elderly; they come into our office and talk about their children who send them money from time to time, but they too are caught in the squeeze. On the one hand they

have their children and on the other hand they have their parents and they themselves have to pay the high medical charges that are almost bankrupting the health of our Nation.

Now we hear of many proposals to close the gaps in medicare. You speak to the man in the street and tell him about insurance to cover the gap in medicare. He will tell you in his own way, "Gaps? Eliminate deductions and the coinsurance and you will cover a major gap." Do we need more insurance to cover the weaknesses of a congressional insurance law or plan? Will the new insurance plans cover prescription drugs, eyeglasses, hearing aids, and so on? We must control hospital costs, something that can't be done while the doctor orders treatments and hospitalization and does not concern himself with costs, because he is not even aware of what they are.

Nursing homes are in the same category, a part of a system that spells out the primary objective. The primary objective in the whole health system is profit and nothing else.

We also have plans for catastrophic health insurance. The plan is well named, for indeed it would be a catastrophe. You can picture a $500 deductible. How many more unnecessary operations would be performed to reach $120, plus long hospitalization and the overutilization of services?

Mr. Chairman, for too many years we have been applying BandAids to assist the one change.

We have been treating the effects and not the cause. One way to attack the cause would be by consideration and passage of H.R. 5191, the House Care for All Americans Act. The plan would create the reforms in our health system. It would eliminate the suicidal catastrophic illness. We are told by some people that H.R. 5191 would cost too much. The Nation today is spending $220 billion per year on health costs. This includes, of course, Blue Cross and Blue Shield, and medicare and medicaid and other medical services provided.

To start with, H.R. 9151, it may cost more, but as the system is reformed and corrected through controls, the costs will certainly be much less within a few years than the costs under the present system.

Mr. Chairman, again I say to you, speak to the man in the street and you will hear remarks like, "Why can't we enjoy the system of health protection that Members of Congress enjoy," or "If this system is good enough for us, why is it not good enough for Members of Congress?"

I am grateful for your attention and hope with millions of Americans that H.R. 5191, Health Care for All Americans, will become the law for the American people.

Thank you for the courtesy of listening to me.

[The prepared statement follows:]

STATEMENT OF MAX SERCHUK, DADE COUNTY COUNCIL OF SENIOR CITIZENS

My name is Max Serchuk, and I am president of the Dade County Council for Senior Citizens, and chairman of the Florida Coalition for Health Security. Our offices are at 1370 Washington Ave., Miami Beach.

I am here today speaking for our 50,000 members in Florida affiliated with the National Council of Senior Citizens. My knowledge comes from what I have learned while serving on the south Florida health systems agency, and the day to day experiences of our members that come to our office.

In Miami Beach with a population of 92,000 people, over 50 percent are social security recipients. Our membership living on fixed incomes, need a major illness to be able to profit by the help medicare extends to them.

The rising cost of medical services makes it more and more difficult for our people to avail themselves of needed health services.

Let's take a look at rising costs. One must recognize that new methods of treating disease require personnel and procedures that are costly.

Secondly, more use of hospitals to treat diseases. Thirdly, we are living to older ages where more diseases occur. And fourthly, there is the old question of supply and demand, with the demand now rising faster than the supply of health personnel, and all these reasons contribute to higher health costs. Add the fact that there is no real control of health costs, we can only foresee under present conditions, costs will go higher.

In our city, on Washington Avenue you see an elderly person crossing the street where there is a no jaywalking sign, or crossing the street with the traffic lights against him. He is violating the law, and if a police officer is around he gets a ticket and there is a $5 fine. These people are not breaking the law, they can't see, and need glasses, but cannot afford the doctor or the glasses. We talk about reasonable costs and medicare. Reasonable costs to most of our people is a cruel hoax. In the first place many can't afford the $60 deductible or the 20-percent coinsurance and if that is not bad enough, there is rarely a "reasonable charge” and the patient usually winds up paying almost 50 percent of the doctor's charge.

Yes! The average senior citizen on Miami Beach lives with the sword of Damocles over his head. That sword is sickness. Where does he go if he can't afford a doctor? He either gives up something that he needs, and sometimes it is part of his food, or as sometimes happens by going to a doctor and accumulating bills, he cannot pay, he sometimes sells his house to pay his medical bills. However on Miami Beach he has another alternative. He goes to one of the many clinics that are opening up on Miami Beach. Some of these clinics have as many as 10 doctors treating the patients. My members tell me that the usual procedure is, on your first visit you usually get an EKG, X-rays and blood tests and the bill to medicare is usually around $125. Of course these services were rendered, but were they needed?

Speaking of the plight of the senior citizens one must realize that exhorbitant health costs affects not only the elderly. They come into our office and talk about their children who send them some help from time to time. But they too are caught in a squeeze. On the one hand they have their parents, on the other hand they have their children, and they themselves have to pay the high medical charges that is almost bankrupting the health of our Nation.

And now we hear of the many proposals to cover the gaps in medicare. Speak to the man in the street and tell him about insurance to cover the gap in medicare. He will tell you in his own way. "Gaps? Eliminate the deductibles and coinsurance and you will cover a major gap." Do we need more insurance to cover the weaknesses of a congressional insurance plan?

Will the new insurance plans cover prescription drugs, eye-glasses, hearing aids, etc?

We must control hospital costs, something that can't be done, while the doctor orders treatment and hospitalization, and does not concern himself with costs because he is not even aware of what they are. Nursing homes fit into the same category, they are all part of the system that spells out the primary objective, profit.

We also have plans for catastrophic health insurance. The plan is well named for it would indeed be a catastrophe. I just picture the deductible of $2,500. How many more unnecessary operations would be performed to reach the $2,500. The prolonged hospital stays and the over-utilization of services.

Mr. Chairman, for too many years we have been applying Band-Aids to a system that won't change by itself. We have been treating the effects, and not the cause.

One way to attach the cause would be by consideration and passage of H.R. 5191-"The Health Care for All Americans Act". This is a plan that would create the reforms in our health system. It would eliminate the suicidal cost of catastrophic illness.

There would be reforms all the way down the line, so that no one would be denied health benefits and everyone would be entitled to the medical care they need.